The dead-infant speaker (p. 378)
the mother, after a painful D&C for the impacted placenta she’d carried inside, then spent the next four months on the locked ward of Metropolitan State Hospital in Waltham MA, psychotic with Denial-deferred guilt and cocaine-withdrawal and searing self-hatred
Context
The speaker's arc passes through the theme's institutional territory: four months on a locked ward, psychotic — the guilt she'd deferred through months of Denial landing all at once, her psychosis explicitly compounded of self-hatred rather than any outside Cause.